PT - JOURNAL ARTICLE AU - Seymour Diamond TI - Strategies for migraine management DP - 1991 May 01 TA - Cleveland Clinic Journal of Medicine PG - 257--261 VI - 58 IP - 3 4099 - http://www.ccjm.org/content/58/3/257.1.short 4100 - http://www.ccjm.org/content/58/3/257.1.full SO - Cleve Clin J Med1991 May 01; 58 AB - According to widely accepted theory, migraine is a self-limited neurogenic sterile inflammation characterized by initial cerebral vasoconstriction, subsequent extracranial and intracranial vasodilation, sterile inflammation, and secondary muscle contraction. It is characterized by recurrent attacks of headache, usually unilateral and accompanied by nausea, vomiting, and, often, other symptoms. Frequency, duration, and intensity of attacks are widely variable. Migraine affects more women than men, and is often related to menses. Patients with classic migraine experience visual or neurologic prodromes, but vague "premonitions" occur in both classic and common migraine. Precipitating factors include foods, alcohol, medications, visual stimuli, changes in routine, and stress. The first-line agent for abortive therapy is ergotamine; corticosteroids are indicated for prolonged headache. Propranolol is recommended for daily prophylactic therapy, and alternatives include calcium channel blockers, nonsteroidal anti-inflammatory agents, and tricyclic antidepressants.